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General Considerations for Treatment of TB Fact Sheet										Related Pages
										**General Considerations for Treatment of TB Disease**
**Introduction**
Treating tuberculosis (TB) disease benefits not only the individual patient but the community as a whole.Thus, any health care provider undertaking treatment of a patient with TB, whether a public health or private practitioner, is assuming a public health function that includes the responsibility for not only prescribing an appropriate regimen but also ensuring the patient’s adherence to the regimen until treatment is completed.
**Recommended Regimens**
There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens are:
isoniazid (INH),
rifampin (RIF),
ethambutol (EMB), and
pyrazinamide (PZA).Regimens for treating TB disease have an *intensive phase* of 2 months, followed by a *continuation phase* of either 4 or 7 months. The continuation phase should be extended to 28 weeks for patients who have cavitation on the intensive chest film *and* positive sputum cultures after 2 months of treatment. Treatment completion is determined by the number of doses ingested over a given period of time. Although basic TB regimens are broadly applicable, there are modifications that should be made under special circumstances (i.e., HIV infection, drug resistance, pregnancy, or treatment of children). Listed below are the basic regimens; please refer to *Treatment of Tuberculosis1* for all options for the treatment of drug-susceptible TB.
**Basic TB Treatment Regimens**
List of Basic TB Treatment Regimens
Preferred Regimen
Alternative Regimen
Alternative Regimen**Intensive Phase**
Daily INH, RIF, PZA, and
EMB* for 40-56 doses** (8 weeks)
**Intensive Phase**
Daily INH, RIF, PZA, and EMB* for 14
doses (2 weeks), then three-times weekly for 18 doses (6 weeks)
**Intensive Phase**
Three-times-weekly INH, RIF,
PZA, and EMB* for 24 doses (8 weeks)**Continuation Phase** ****Daily INH and RIF for 90-126
doses**(18 weeks)
or
three-times weekly INH and RIF for 54 doses (18 weeks)
**Continuation Phase**
Three-times-weekly INH and RIF for 54 doses (18 weeks)
**Continuation Phase**
Three-times-weekly INH and RIF for 54 doses (18 weeks)** EMB can be discontinued if drug susceptibility studies demonstrate susceptibility to first-line drugs.
** Guidelines allow dosing 5 or 7 days-a-week; 5 days-a-week administration by DOT is an acceptable alternative to 7 days a-week administration.*
**HIV-negative Persons**
A continuation phase of once-weekly INH and rifapentine can be used for HIV-negative patients who do not have cavities on the chest film and who have negative acid-fast bacilli (AFB) smears at the completion of the intensive phase of treatment.
**Case Management**
Patient-centered case management should be used in the treatment strategy with an adherence plan that includes directly observed therapy (DOT). DOT is a strategy in which a health care worker or another designated person watches the TB patient swallow each dose of the anti-TB drugs. All patients taking drugs fewer than 7 days per week (e.g., 1, 2, 3, or 5 days a week) *must* receive DOT.
**Follow-up Evaluations**
Sputum specimens for microscopic examination and culture should be obtained from patients diagnosed with TB disease at a minimum of monthly intervals until two consecutive specimens are negative on culture. It is critical to obtain a sputum specimen at the end of the intensive phase (2 months) to determine if the continuation phase should be extended. In addition, it is essential that patients have clinical evaluations at least monthly to identify possible adverse effects of the anti-TB medications and to assess adherence. All patients with TB disease should have counseling and testing for HIV.
**For More Information**
Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis. (2016). Available online at http://cid.oxfordjournals.org/content/63/7/e147
Special Considerations for Treatment of TB Disease in Persons Infected with HIV (Fact Sheet). Available online at https://www.cdc.gov/tb/publications/factsheets/treatment.htm
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						Page last reviewed:  September 21, 2016					Content source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention homeTuberculosisBasic TB Factsplus iconHow TB SpreadsLatent TB Infection and TB DiseaseSigns & SymptomsTB Risk FactorsExposure to TBTB PreventionVaccinesTB & HIV CoinfectionTB and DiabetesTB TermsPersonal StoriesTesting & Diagnosisplus iconWho Should be TestedTesting for TB InfectionTesting in BCG-Vaccinated PersonsTB Screening and Testing of Health Care PersonnelTesting During PregnancyDiagnosing latent TB infection and TB diseaseTreatmentplus iconDeciding When to Treat Latent TB InfectionTreatment Regimens for Latent TB Infection (LTBI)Treatment for TB DiseaseAdverse EventsTB Treatment of Persons Living with HIVTB Treatment and PregnancyTB Treatment for ChildrenFrequently Asked QuestionsDrug-Resistant TBResearchplus iconTB Epidemiologic Studies Consortiumplus iconResearch ProjectsPublicationsTB Trials Consortiumplus iconStudy DescriptionsBackgroundBehavioral & Social Science ResearchHealth Care Settingsplus iconTB Infection Control in Health Care SettingsResources for TB Screening and Testing of Health Care Personnelplus iconFrequently Asked QuestionsTB in Specific Populationsplus iconHealth DisparitiesAsian PersonsBlack or African American PersonsHispanic or Latino PersonsChildrenPregnancyCorrectional FacilitiesPeople Experiencing HomelessnessInternational TravelersLaboratory Informationplus iconDrug Susceptibility TestingFalse-Positive Investigation ToolkitInterim Laboratory Biosafety Guidance for XDR  tuberculosis strainsModel Performance Evaluation Program (MPEP)Rapid Molecular Testing to Detect Drug-Resistant TB in the USplus iconExecutive SummaryIntroductionBackground on Tests for Molecular Detection of DRGeneral Considerations and Principles for a Molecular DR Testing ServicePossible Scenarios and Scope of Testing for a Molecular DR Testing ServiceResearch NeedsGeneral Recommendations of the Expert PanelCommunication Plan for the ReportRecommendationsReferencesPanel Members and CDC ParticipantsAppendix 1Appendix 2Appendix 3The Uses of Nucleic Acid Amplification Tests for the Diagnosis of TBplus iconGeneral ConsiderationsGeneral Recommendations of the Expert PanelRecommendations to ACET, CDC, DTBEData & Statisticsplus iconTB Incidence in the United StatesReported TB in the US, 2022 Surveillance Reportplus iconNational DataReporting Area DataRisk FactorsDemographicsTB Treatment and Case OutcomesDrug-Resistant TBMolecular SurveillanceTuberculosis in the United States, 2022 (Slide Set)Archived Surveillance Reports and Slide Sets2021 State and City ReportArchived State and City ReportsProfessional Resources & Toolsplus iconTools for Healthcare ProvidersResources for TB Programsplus iconStrengthening Civil Surgeons’ Capacity to Improve LTBI Surveillance and Outcomes Among Status AdjustersNotice of Funding Opportunity (NOFO)Program EvaluationTB Centers of ExcellenceTB Elimination AllianceTB Genotypingplus iconConventional TB GenotypingWhole Genome SequencingTB GIMSAnalytic ToolsLatent Tuberculosis Infection ResourcesPublications & Productsplus iconPatient and Public MaterialsFact SheetsGuidelinesplus iconControl & EliminationDrug-Resistant TBInfection Control & PreventionLaboratory & GenotypingTB & HIVTB in Specific PopulationsTesting & DiagnosisTreatmentVaccines & ImmunizationsArchived TB GuidelinesGuides & Toolkitsplus iconAggregate ReportsCDC TB Surveillance TrainingCore CurriculumEffective TB Interviewing for Contact InvestigationEthnographic GuidesFalse-Positive Investigation ToolkitForging Partnerships to Eliminate TuberculosisGuide to Application of GenotypingLTBI: A Guide for Primary Health Care ProvidersMantoux Tuberculin Skin Testing ProductsReport of Verified Case of Tuberculosis (RVCT)Self-Study ModulesTB Contact Investigation Interviewing Skills CourseTB eDOT ToolkitUnderstanding the TB Cohort Review ProcessNewslettersplus iconTB Notes, No. 4, 2023TB Notes, No. 3, 2023TB Notes. No. 2, 2023TB Notes. No. 1, 2023TB Notes, No. 4, 2022TB Notes, No. 3, 2022TB Notes, No. 2, 2022TB Notes, No. 1, 2022TB Notes, No. 4, 2021TB Notes, No. 3, 2021TB Notes, No. 2, 2021TB Notes, No. 1, 2021Pamphlets, Brochures, Bookletsplus iconQuestions and AnswersPatient Education SeriesTuberculosis - Get the FactsTuberculosis - The Connection between TB and HIV12-Dose Regimen for Latent TB Infection-Patient Education BrochurePostersplus iconMantoux Tuberculin Skin Test Wall ChartWorld TB DayThink TBStop TBTake on TBReports & Articlesplus iconDTBE Authored Journal ArticlesTuberculosis Laboratory Aggregate ReportsSlide Setsplus iconIntroduction to TuberculosisEpidemiology of Tuberculosis Among Non-U.S.​–Born Persons in the United States, 1993–2016Self-Study Modules on Tuberculosis, 1-5 Slide SetsThe Tuberculosis (TB) in Correctional Settingsplus iconFacilitator GuideIntroduction to TB GenotypingEpidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2017Prevention and Control of Tuberculosis in Correctional and Detention FacilitiesGuidelines for Preventing the Transmission of M. TB in Health care SettingsInvestigation of Contacts of Persons with Infectious TBEpidemiology of Pediatric Tuberculosis in the United StatesTargeted Tuberculosis Testing and Treatment of Latent Tuberculosis InfectionElectronic Tools & ResourcesWeb-Based Courses & Webinarsplus iconTB 101 for Health Care WorkersContent SyndicationInfographicsplus iconSocial Media GraphicsCustomizable Take on TB Infographic with InstructionsEventsWorld TB Dayplus iconU.S. TB ChampionsHistoryFeaturesplus iconTB Risk FactorsTreating Latent TB Infection with Short-Course RegimensWorld Tuberculosis (TB) Day 2021World Tuberculosis (TB) Day 2020Linksplus iconState TB Control OfficesAbout Usplus iconMission Statement and Activitiesplus iconDTBE Strategic PlanNational TB Program ObjectivesOrganization ChartAdvisory Groupsplus iconFederal TB Task Force To receive email updates about this page, enter your email address: Email Address			What's this?				Submit


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